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Type 1 Diabetes

T1D (formerly known as juvenile-onset diabetes) is an absolute insulin deficiency caused by autoimmune destruction of insulin-producing β cells in the pancreas. Around 5-10% of diabetic cases are T1D, usually affecting children (0-14 years) and young adults (15-19 years), causing severe blood sugar fluctuations that require lifelong insulin treatment to survive.

Risk factors for T1D are still being investigated but include environmental factors, genetic predisposition and viral infections that trigger insulitis and β cell injury from both cellular (T cell) autoimmunity and humoral auto-antibodies responses that lead to a loss of insulin response initially in the pre-diabetic phase and then glucose intolerance in the diabetic phase with a severe loss in beta cell mass. There is an estimated 8 million adults diagnosed with T1D and over 78 000 children develop T1D globally every year, with incidence rising 3.0% per year in children aged 0-14 years.[1,2]

Currently T1D cannot be prevented, but there is ongoing research to control the environmental factors that trigger the body’s autoimmune destruction of insulin-producing cells.

 

T1D is acute with the primary clinical signs being ketoacidosis and hypergylcaemia, and other symptoms including frequent urination, increased thirst, increased appetite, fatigue, weight loss, lack of concentration, slow-healing wounds and recurrent infections. Other symptoms may include tingling or numbness in the hands or feet, blurred vision, and vomiting and stomach pain if ketoacidotic.

The current treatment (standard of care) for T1D is constant blood sugar monitoring and multiple daily insulin therapy (delivered via injection, infusion pump or transdermal patches) to stabilise blood sugar levels. The goal is to optimise blood sugar control and minimise complications. There is currently no cure for T1D; treatment is palliative only with limited efficacy, providing imperfect sugar control and undesirable side effects that lead to patient compliance issues, diabetes complications and a high patient and public healthcare burden. Testing methods have improved and better forms of insulin have contributed to improved sugar control and higher life expectancy, but adverse consequences are a major risk for T1D patients. Many diabetic patients on standard insulin therapy find it difficult to maintain tight sugar levels within the normal range. Side effects of insulin therapy include pain, weight gain and importantly hypoglycaemia that can result in seizures, unconsciousness, brain damage and death.

Chronic hyperglycaemia damages capillaries and small blood vessels in multiple tissues and organs, leading to severe secondary diabetes complications including cardiovascular disease, neuropathy, retinopathy, nephropathy (leading to kidney failure) and strokes that are irreversible, which result in increased morbidity and mortality. Importantly, quality of life is significantly decreased, and people with T1D have a reduced life expectancy by 20 years on average.

References:

[1] Gottlieb P, Eisenbarth G & Skyler J. Immunopathogenesis of Type 1 Diabetes: Approaches to Prevention and Cure. Accessed www.docstoc.com/docs/525462

[2] International Diabetes Federation. IDF Diabetes Atlas Fifth Edition (2011). 2011. http://www.idf.org/diabetesatlas/5e

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